100407043-4-28-2022-04-CC-CHAS-CDWSXX-20220428141639

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 100407043
Report Date: 04/28/2022
Date Signed: 04/28/2022 02:16:54 PM

Document Has Been Signed on 04/28/2022 02:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	JEFFERSON PRESCHOOL		FACILITY NUMBER:	100407043
ADMINISTRATOR:	LORI WELCH		FACILITY TYPE:	850
ADDRESS:	1110 TUCKER AVE		TELEPHONE:	(559) 524-6290
CITY:	SANGER	STATE: CA	ZIP CODE:	93657
CAPACITY:	30	CENSUS: 17	DATE:	04/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Sandra Olivo		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/28/22 an unannounced Annual inspection was conducted today by Licensing Program Analyst, (LPA) Caroline Harris. LPA met with Supervisor, Sandra Olivo, and toured the facility, both indoors and outdoors. This facility is a single classroom housed on the Sanger Unified – Jefferson Elementary School campus. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were seventeen day care children present. This facility runs two half day programs. The AM session is from 8:00AM to 11:00AM and PM session is from 12:00 PM to 3:00 PM. Breakfast is provided to the AM session and lunch is provided to the PM session, and meals are eaten at the elementary school cafeteria. All kitchen, food prep, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and contaminated food is discarded immediately. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, are in good repair.All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) or less. Menus are posted at least one week in advance, where an authorized representative can view them. Firearms/weapons or ammunition are not allowed or stored on the premises. All children are to be under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. The LPA did not observe disinfectants, cleaning solutions and other dangerous items to be accessible to children. There were no poisons observed on the premises accessible to children. Licensee is aware that poisons are required to be locked and inaccessible to children. All materials and surfaces accessible to children are toxic free. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JEFFERSON PRESCHOOL	FACILITY NUMBER: 100407043
	VISIT DATE: 04/28/2022

NARRATIVE

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The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. Uncontaminated drinking water is available both indoors and outdoors. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings, and slides have cushioning material to absorb falls. There were no bodies of water on site.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. There are no excluded individuals present at this facility. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the facility and prevented from returning to the center or having contact with children in care. The licensee shall comply with the notice. Staff records contain appropriate, documentation of education credits. At least one person is to be trained in CPR and Pediatric first-aid and shall be present when children are at the facility or at off-site activities. This facility does have one person trained in CPR and first aid. LPA reviewed with Ms Olivo the Mandated Child Abuse Reporter Training (AB 1207). Three out of four staff files did not have proof of completion. Ms Olivo is aware that the Mandated Reporter Training is required to be updated every two years. Information on Lead Poisoning was also provided to the licensee and she was informed that the information is required to be posted on the parent board. The LPA and licensee discussed the Community Care Licensing website: www.ccld.ca.gov. which provides access to Provider Information Notifications (PINS), Quarterly Updates that inform licensees of new legislation and regulations, training's, and Licensing forms and updated information. The licensee was also advised that it is her responsibility to stay current with regulations. Fire drills are conducted and documented with the date, time and how many children present, every six months. The person, who signs the child in/out, is responsible for the child, uses their full legal signature and records the time of day. Child's admission agreement is available for review.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JEFFERSON PRESCHOOL	FACILITY NUMBER: 100407043
	VISIT DATE: 04/28/2022

NARRATIVE

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The LPA reviewed six children’s files. All required licensing documents were observed in each of the children’s files. Licensee also maintains documentation of immunizations for the children, however they are not transcribed. Incidental Medical Services (IMS) policy was discussed. This facility does not provide Incidental Medical Services (IMS). The licensee is aware that an IMS plan is required to be submitted to the licensing office if they choose to provide any of these services.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiencies are found: (see LIC809-D)

An exit interview was conducted and a copy of this report along with appeal rights was provided and reviewed with Ms Olivo. This report shall be made available to the public upon request. The LIC 9213 Notice Of Site Visit form was given to Ms. Olivo and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/28/2022 02:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JEFFERSON PRESCHOOL	FACILITY NUMBER: 100407043
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229(a)(1)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	During the inspection, the LPA observed children going in to the bathroom (one at a time) and closing the door or keeping it slightly open, but the staff could not see the children. The staff were also observed to be standing at the doorway of the building and not close to the bathroom. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/12/2022
	Plan of Correction
1 2 3 4	Ms. Olivo agrees to have her staff review the CCL training, "Supervising Children in Child Care Centers" and have the sign in sheet available for review by the due date of 5/12/22.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, three out of four staff files reviewed did not have proof of completing the Mandated Reporter training. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/12/2022
	Plan of Correction
1 2 3 4	Ms. Olivo agrees to have proof of all staff completing the Mandated Reporter training, for review in the staff files, by the due date of 5/12/22.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/28/2022 02:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JEFFERSON PRESCHOOL	FACILITY NUMBER: 100407043
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101170(d)

Criminal Record Clearance

(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review two out of four staff files reviewed did not have signed Criminal Record Statements. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/12/2022
	Plan of Correction
1 2 3 4	Ms. Olivo agrees to have proof of all staff's Criminal Record Statements available for review by the due date of 5/12/22.

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, copies of children's immunizations were old copies and had not been transcribed onto blue cards. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/12/2022
	Plan of Correction
1 2 3 4	Ms. Olivo agrees to have updated immunization information in each child's file and immunizations transcribed and available for review by the due date of 5/12/22.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

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